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Who cares
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Sponsors
No co-sponsors yet.
History
- Referred to health
- Referred to health
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Relates to clarifying the grounds for an external appeal based on medical necessity
In Senate Committee · Health · Sponsor Richard Gottfried
Full text
The text isn't available here yet. Check nysenate.gov.
Sponsor's memo
Title of bill
An act to amend the public health law and the insurance law, in relation to clarifying the grounds for an external appeal based on medical necessity
Purpose
To clarify the grounds for an external appeal based on medical necessity
Summary of provisions
This bill would provide that where an external appeal is based on grounds of medical necessity, the insured shall have the opportunity to demonstrate, through his or her health care professional, based on applicable medical and scientific evidence, the patient's medical record, and any other pertinent information, that the proposed health care service or procedure is likely to be more beneficial than any standard treatment or procedures. This legislation would not require a health care plan to cover any health care service or procedure that would be excluded from the coverage under the policy for reasons other than medical necessity.
Existing law
New bill.
Justification
Where there is a sound medical and scientific basis for a health care service or procedure, a patient should not be denied access to that care. Yet that is not clearly the rule in the external appeal system. The current language in the external appeal law provides only very general grounds for determining an appeal of a denial based on medical necessity. This bill would facilitate evidence-based appeals founded on medical and scientific literature, the patient's medical record, and other pertinent information.
Key terms in this bill, such as "health care professional" and "medical and scientific literature," are defined terms in the external appeal law.
Legislative history
This is a new bill.
Fiscal implications
None.
Local fiscal implications
None.
Effective date
This act shall take effect on the one hundred eightieth day after it shall have become law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.